(272) Differential Risk of Osteoporotic Fractures Associated with Use of Antipsychotics: A Systematic Review and Meta-Analysis

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 603

Presenting Author(s)

Dana Alsugeir
– PhD student , Imam Abdulrahman Bin Faisal University, London, United Kingdom

Co-Author(s)

Matthew Adesuyan, MPharm
– Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom., University College London, London, United Kingdom
Basma Alfageh
– King Saud University, Saudi Arabia
Li Wei
– Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom, United Kingdom
Ruth Brauer, PhD
– Lecturer in Pharmacoepidemiology, University College London (UCL), England, United Kingdom

Background: Osteoporotic fractures are a debilitating condition associated with high morbidity. Several reports have linked use of antipsychotics to the development of osteoporotic fractures by increasing serum prolactin. However, it is not clear which antipsychotic medication has a higher risk of developing osteoporotic fractures.

Objectives: To summarize evidence on differential risk of osteoporotic fractures associated with use of antipsychotic medications.

Methods: Observational studies were retrieved by searching PubMed, EMBASE, and PsychINFO up to January 2022. We included analytical studies in which the risk of osteoporotic/any fractures in users of individual antipsychotic medications was compared to the risk in non-users. In conducting the search, two reviewers screened full-text articles for inclusion, performed data extraction and assessed risk of bias using the Newcastle-Ottawa tool. A meta-analysis was conducted for 1) risperidone and 2) haloperidol versus non-users of antipsychotics using a random-effects model.

Results: In total 1,595 titles and abstracts were screened, and 50 studies were reviewed in full text. The inclusion criteria were met by eight studies. Antipsychotic-user populations varied; two studies included individuals older than 65. Three studies included individuals diagnosed with schizophrenia and parkinsonism. Whereas three studies included general antipsychotic users. The highest risk of fractures was associated with haloperidol, zulcopentixol, risperidone, olanzapine and quetiapine use. However, included studies were not directly comparable due to differences in comparator choice and study design. Therefore, only four studies comparing risperidone use and three comparing haloperidol use to non-antipsychotic use were included in the meta-analysis. There was no evidence of an association between use of risperidone and development of osteoporotic fractures (OR=1.12, 95% CI 0.94-1.33), with moderate variability between studies (I2=27%). On the contrary, haloperidol use was associated with increased osteoporotic fractures risk (OR=1.68, 95% CI 1.01-2.78) compared to non-use with high variability (I2=77%).

Conclusions: The findings of this review suggest a higher risk of osteoporotic fractures associated with the use of first-generation antipsychotic medications, particularly haloperidol.